rules of injections

[imahobbit]

been doing it a long time and will not bend--learned you draw what you shoot and only shoot what you have drawn! have pressure to shoot what others draw up--still refusing!!!!

Where do I find this guideline to show to "powers in charge"????? Have looked all over tx board website it's my license at stake(they don't have one) or my job HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Midwest4me]

I have to agree with Newfie. Pharmacy makes so many errors as it is. Who would be liable if I gave a mislabeled drug from pharmacy. Anyone know?

In my opinion the pharmacy would be at fault; after all, the label is applied by them.

[hanzz]

I'm still a nursing student and I absolutely agree on not giving meds when it was drawn up by others....

[acynicalnurse]

I agree with the RN about pharmacy prepared IVAB's cos they are time related and also some are so like named imagine a mix up by a pharmisist then if the patient has an anaphylaxis response due to known allergy. Who do you think would get the blame and be resoponsible even if its a pharmacy error. The Nurse would cos they administered it. :angryfire

Then alternatively have seen opiates for epidurals that we are supposed to trust but are all signed for by two RN's so what are you to do.?!

[frosteefire]

Hi!

Just another perspective from a different area...I work in a neurosurgery/trauma ICU....We often draw up certain meds (for ONE patient) for multiple uses. This becomes quite handy during procedures (central line insertions /intubations /bedside trach's) and with +++ agitated or unstable pts. This is certainly more realistic than running to the narc/med room everytime the doc calls for 100 mcgs of fentanyl, 2 mg. morphine, etc etc.

We have policies for the standard concentrations we use to mix up particular drugs(eg. 10 mg/1cc morphine vial - add 9cc SW for final concentration 1mg/ml). In the case of Morphine and Fentanyl, in fact, we have syringe labels (stickers), which are preprinted with the med name and standard concentration - we are just to write in the pts name, date/time it was mixed/drawn, and the initials of the person drawing. We may mix these up for ourselves, or for another nurse who is in an unstable situation.

There are many potentially dangerous meds which we mix up and label in i.v. bags for infusion - norepinephrine, heparin, rocuronium, insulin, to name a few. These, as they hang infusing, are passed on to the next nurse on duty when our shift ends, with only our signature on the bag to confirm that the concentration is as written. This too implies a high level of trust in the previous nurse - Would one suggest that we should be mixing up new infusion bags with the beginning of each shift? I hope not!!

If properly labelled as per policy in our area, these premixed syringes are just as safe as those IV bags.

As posted by others, I think in certain settings premixed syringes are necessary.

Thanks for hearing me out Anybody else out there with similar policies?

[Overland1, RN]

If there is syringe left anwhere in my hospital, it mysteriously disappears into the nearest sharps container. Usually, whoever drew it up will start looking for it and asking others if they have seen it. When they get to me, I point to the sharps box and smile, then remind them that no syringes are to be left out, nor left in any patient's room. It is a simple policy.

As for pushing something that another nurse/doc drew up, the only exception is if they drew it up while I was watching them do so, and could verify the Five Rights (Time, Route, Amount, Medication, and Patient..... makes a great acronym ) in the process.

[P_RN, ADN, RN]

1. Don't Do It Ever!

2. See # 1

[SharonH, RN]

If there is syringe left anwhere in my hospital, it mysteriously disappears into the nearest sharps container. Usually, whoever drew it up will start looking for it and asking others if they have seen it. When they get to me, I point to the sharps box and smile, then remind them that no syringes are to be left out, nor left in any patient's room. It is a simple policy.

As for pushing something that another nurse/doc drew up, the only exception is if they drew it up while I was watching them do so, and could verify the Five Rights (Time, Route, Amount, Medication, and Patient..... makes a great acronym ) in the process.

I've also tossed quite a few in my time. I see a syringe laying around, goodbye, it's gone, no apologies.

[Sodie, BSN, RN]

Hey all,

I do give injections that others have drawn. I know this is a no-no, they drilled it in our heads never to do this in nursing school. But as you all know ... nursing school typically does not show us the "real world". I think in nursing school that they have an oblegation to teach students the, textbook way. However we have all learned that a lot of it certainly is not reality. I am very concience regarding med admin, and have never had a problem with this. This is not to say that I always do it...depends on the med, who drew it up. I feel that I can safely trust about 90% of my coworkers....we are fortunate to have exeptional RN's in our unit :)

Just wanted to be honest and tell you what I do.........

I would not advise it, as you certainly can run into troube.

Thanks...christen

One time a nurse in my unit gave something that another nurse drew up. It was neosenephrine. It was 10 times the dose that it should have been. Fortunately the patient didn't have any residual effects.

I never give anything that someone else drew up or mixed other than a pharmacist that has labeled the syringe. It has been my practice for 16 years; I have shared this with all nurses that I have precepted and I discourage it today as I teach IV therapy classes.

Most of the nurses that I have spoken with about administering meds that they did not draw up state that they don't do that either and never will.

[littlebitonurse]

If you give meds according to the 5 Rights, you would absolutely refuse to give something you had not drawn or witnessed being drawn. How can you say Righ Med? if you only have another nurse's word that it is what it is supposed to be. I saw a very good nurse learn that lesson the hard way--she gave an IM of what she was told was demerol--she had barely came out of the patients room when the nurse who drew up the med came running and said it was the wrong drug--luckily for both of them no harm came to the patient.

[analee23]

We often give rocephin IM in my ER divided in two doses for lil kiddos. It's always arranged that the second RN watches you pull up, verifies dosage, and then helps admin. It's a good system and it works very well. Just have to get the RN there before you draw it up (not mixing... you can mix without them there). Not too hard folks, just take the extra few seconds. to verify.

[BK05]

I am a fairly new LPN of 1yr. experience. What I have come to find is that it does not matter who your co-workers are, when it comes to their butts or yours, they will screw you. Yes in school they taught us the correct ways for a reason. I understand that we may have to cut corners, but that is a corner I would walk the whole way around. You have come to far to let something like giving a med that someone popped or drew up to loose it all... Just follow your heart when it comes to those kinds of issues, and you will do the right thing.

[mahjia]

wow i like your guts...hope i have it too... we are taught in school to do whats in the book..and to follow the universal rule in giving medication but lets face the reality...our own CI's bend the rule.. some of our CI's allows us to give or inject what we didnt prepare.. and i hate myself, the fact that i know it is strongly not right, cause i still gave it ..without asking and sometimes never give a damn if it is the right med or not.. how pathetic i am, huh!

but your 'piece' gave me something to think of.. thanx!